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General NPI Number Information
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NPI Number | 1568417368
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Entity Type | Individual
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Provider Name | BRADFORD NOLL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 7950 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4140
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Country | US
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Telephone | 260-435-7001
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Fax | 260-407-8008
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Provider Business Mailing Address
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Address Line | 58 HATHAWAY AVE
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City | BEVERLY
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State | MA
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Zip | 01915-1438
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Country | US
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Telephone | 978-927-9312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number |
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License Number State |
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